The stages of labour: What REALLY happens when you give birth? One midwife reveals all!

Isn't it funny how when you're pregnant, other mums often 'gloss over' the stages of labour and intimate details of birth until after you've had your baby?

It's almost as though, once you've had your little one, you join an exclusive club that makes it okay to talk about the more 'undignified' (and often, rather gory) realities. But sometimes it can be better to be prepared for what could really happen during labour and birth!

From the signs of labour, the stages of labour and all the way through to the birth, one person who's all too familiar with the realities of having a baby is midwife Anne Richley. Here, she exposes some of the secrets behind labour, birth and recovery!

Waters breaking

For most women, their waters won't break until they're in established labour. The bag of fluid often ruptures at the height of a contraction, imagine a balloon full of water being squeezed.

For some mums-to-be, their waters will break before the contractions start and many dread this happening towards the end of their pregnancy. But it's certainly no reason to become a recluse.

The baby's head usually acts like a plug when it moves down into the pelvis, so when the waters break it's not as dramatic as it sounds. It can start as a trickle, and you may have to smell it to distinguish it from a leaky bladder - the amniotic fluid has a slight 'almond' aroma. It'll look the same as straw-coloured urine. Just put on a sanitary towel and keep an eye on it. If it's your waters, the trickle will continue. Altogether there's around enough fluid to fill a wine bottle, but it's unusual for it to burst with a 'gush' before labour starts.

It doesn't hurt when your waters go. You might feel a 'pop', then warm fluid trickling out of your vagina. You could always wear a sanitary towel towards the end of your pregnancy, just in case they break while you're out and about.

If you suspect your waters have broken or are still unsure, contact your midwife, who'll want to check that you and your baby are well. Once you've been given the okay, and assuming all is well, labour will probably start within 36 hours.

Contractions

Labour talk usually centres on how many centimetres wide the cervix is. It sounds as though the midwives need a tool kit, complete with tape measure, but don't worry, this certainly isn't the case!

Your cervix is part of the womb and sits at the top of your vagina. Before labour starts it feels like a little tube with a dimple in it (try putting your finger in your nostril, it feels similar to that!).

Once labour starts, contractions help to open the cervix up, and it becomes flatter. Imagine stretching a thin piece of bubble gum, and popping a hole in the middle of it. This is how an 'effaced' (stretched thin) cervix would feel. The hole in it becomes bigger as labour progresses.

If your midwife does a vaginal examination during labour, she feels the cervix with two fingers and, depending on how wide she can open her fingers, estimates how many centimetres dilated you are.

When your cervix is fully dilated, (10cm), the contractions change and the baby's ready to move down the vagina. Many midwives don't do a vaginal examination at this point, as there are other signs to indicate that the cervix has dilated fully. These include the contractions changing, often stopping temporarily, and the woman's anus starting to bulge with the contractions. This is also when a mum-to-be will feel nauseous and may be sick.

Although your cervix is dilating throughout labour, it doesn't mean your vagina is too. The muscles stretch once your baby moves down the vagina in the second stage of labour.

Labour pains

At the risk of being shot down in flames, for the vast majority of us labour does hurt. Don't seek a cure; look at coping: there's a big difference. Relaxation can help get you through it. I don't expect you to drift off to sleep throughout labour (unless you've got a hefty epidural on board), but feeling well supported and in control of things can make a huge difference to the way you deal with the situation.

Contractions gradually build, reach a peak and then, thankfully, start to come down the other side. You'll then get a break before the next one. In early labour this could be 20 minutes, but at the peak of labour it may only be a minute or two. However small a break, you'll be grateful for it!

Opening your bowels

Women often confess to worrying about this more than anything else. Lots of mums-to-be open their bowels during labour, but not in large amounts because, for many women, one of the first signs of labour is getting the runs - nature's way of clearing the bowel beforehand.

When it comes to the second stage of labour, the contractions become 'expulsive', which means you'll get the feeling of needing to bear down or push. There'll still be a trickle of amniotic fluid and usually there'll be blood-stained mucus, so your midwife will be discreetly changing any pads underneath you to help keep you comfortable.

When your baby's head is almost visible, often the point when the bowels open, she'll hold a pad against your back passage and no-one else will even be aware that your bowels have opened.

As your baby's head presses on the rectum you'll feel as though you need to open your bowels, even if you don't actually do so. There's nothing you can do about this, and if you try to 'hold back' you'll only make yourself feel more uncomfortable. You might even feel that you're baby's travelling through your back passage.

Giving birth in water doesn't make you immune to doing a poo. Part of a water-birth 'kit' is a plastic sieve for the midwife to keep the water as clean as possible! One dad said that I looked like a garden gnome with a fishing rod, crouching at the edge of the pool with my sieve! Your midwife is completely used to this, and will dispose of the contents without batting an eyelid.

The reality is that when it comes to giving birth, worrying about opening your bowels will be the last thing on your mind.

After the birth

You may get the 'shakes' and feel cold immediately after the birth. This is all normal and is part of your body adjusting to the change in temperature, loss of fluid and the sheer impact of giving birth. Don't expect your tummy to be flat straight away, you'll still have a bit of a jelly belly for the following few weeks. You might also feel a bit swollen or bruised down below, and shortly after the birth the midwife will take a look to see if you need any stitches.

With a little tear there's usually no need for stitches. But if they are necessary, your midwife will inject some local anaesthetic into the tear and wait for it to make the area numb before she starts.

The stitches are dissolvable, which means there's nothing to be removed afterwards. If you need stitches after a home birth, your midwife might suggest that she does the job while you sit on a towel on the sofa. If you're in hospital, you might be asked to put your legs in stirrups while lying on a bed.

Remember, this is still your birth experience and you should feel comfortable during this procedure. If the tear isn't bleeding, ask for it to be left alone and get the midwife to re-check it after an hour or so.

Painful breastsWhen your milk comes in, around the third or fourth day, you'll know about it! Your breasts become fuller, firm and can feel very 'engorged'. The slightest knock can make you wince. But don't worry, it'll all settle down within a couple of weeks.

If you develop a tender area in a breast and feel 'fluey', you may have mastitis. Try to keep breastfeeding, but contact your midwife or GP as you may need treatment.

Swollen legsMany mums develop swollen feet and legs after giving birth, even if they didn't during pregnancy. It's due to circulation readjusting. For most, it clears in a few days, but some have it for weeks. Whatever kind of birth you had, it's important to exercise your feet soon after. Try a pedalling action, then stretching and relaxing your feet.

Although swelling is normal, pain isn't, so tell your midwife or GP of any pain or inflammation. It might indicate DVT (deep vein thrombosis) which requires immediate attention.

Toilet troubleDon't worry if you don't open your bowels for a few days after the birth, as this is normal. Try to avoid constipation, though, otherwise it'll be more uncomfortable when you do go. Eat lots of fibre, veg and fruit, especially prunes and figs, and drink lots of water. Haemorrhoids (piles) are quite common, but are easily treated with a cream. Sometimes they'll disappear on their own, but see your GP if you're worried.

If you've had a tear, it may sting when you wee. Keep a jug of water by the loo and pour it between your legs when you go. If the pain continues, there's blood in your urine or you feel unwell, contact your midwife or GP, as you may have an infection.

Urinary incontinence is also common after birth, so be sure to do your pelvic-floor exercises. Mention it to your GP if it's still an issue at six weeks.

Love at first sight?Let your midwife know if you want your baby placed straight on you after the birth. Skin-to-skin contact is great for encouraging bonding and breast-feeding and it also helps to keep your baby warm. Some newborns are covered in vernix, a white, sticky substance that helped waterproof the skin and keep then warm in the womb. Others look a bit 'squashed', grumpy and blue, but they're all beautiful!

If you want to breast-feed immediately, then do so. Then again, you might feel exhausted and happy for your partner to hold them while you have well-earned rest.

Some women fall in love instantly with their new baby, but there are plenty who don't. Mums often feel exhausted and just want to sleep, and will gradually grow to love their baby. Not many will admit to this, but it's very normal.

BleedingOnce this has settled, lots of women like to have a bath or shower. Assuming your legs aren't numb from an epidural, this is fine. Your partner or midwife will walk with you to the bathroom, just in case you feel a bit wobbly. Your blood loss will be like a heavy period after the birth, so don't be alarmed at the colour of the bath water, it always looks like there's more when it's diluted.

For the first few days this will continue, so have a supply of super-absorbent sanitary towels ready. If you pass any large clots (bigger than an egg), let your midwife know or save the sanitary towel for her to look at. Occasionally a bit of placenta is left behind, which will hopefully work its way out. Gradually the blood loss will go darker and then change to a mucousy yellow colour that's sometimes stained with blood. This can carry on for up to six weeks, and it's best to avoid using tampons during this time.

Going to the looEven if you don't tear giving birth, you might have a graze in your vagina, which can sting when you pass urine. So keep a jug by the side of the loo and as you do a wee, pour water between your legs to ease the stinging. Or do a wee in the bath just before you get out. This should start to feel better after a few days.

Most women are frightened about opening their bowels after they've had a baby. It's normal to worry that stitches will tear if you strain, but remember that although it's the same area, we're talking about two separate openings.

If you're worried, hold a sanitary towel against the stitches the first time you go to the loo, to make the area feel more supported'. Also, avoid constipation by drinking plenty of water and eating fresh fruit and vegetables.

Recovery

Recovery from birth varies between women. Some mums get straight back into their regular jeans and life continues pretty much as it did before. But this isn't the case for the vast majority. Having a baby is a huge life-changing event and it's unrealistic to expect your life to carry on exactly as 'normal'.

Some women feel a need to 'debrief' following the birth of their baby and this is completely acceptable. Talk to your community midwife or write to the head of midwifery at your maternity unit and ask for an opportunity to go through the notes, if you feel it could be beneficial.For the first few days and weeks

Nap in the day when your baby sleeps, so the nights don't seem as bad

Poor bladder control is common after giving birth. It might be a while before you can get on a trampoline! Start doing those pelvic floor exercises before the birth, and continue to do so afterwards, it should improve.If you had a tear but no stitches, take it easy for a few days and allow the area to heal

If you've had stitches, soak in the bath with four drops of pure lavender oil every day to help soothe them

Have plenty of super-absorbent sanitary towels and breast pads to hand. Initially, you'll feel like you're leaking from every orifice. But give it time, it will all begin to settle down!

There's no restriction on how long you should wait before having sex, if you feel ready, then that's fine. However, the reality is that many women are too exhausted to even contemplate doing anything other than sleep when they go to bed!

If you're finding it difficult to cope, talk to your midwife. She'll visit you at home, and you should also have a contact number if you need to speak to her.

Continued below...

For more information make sure you speak to your midwife or doctor

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Suzanne Fernando

My name is Suzanne Fernando and I was diagnosed with Cervical Cancer when I was pregnant - and almost died before I got a chance to hold my newborn baby girl. The nightmare began when doctors discovered a tumour the size of a tennis ball blocking little Aaron's arrival. They immediately delivered Aaron by C-Sect - but I haemorraged. My bed sheets were soaked in blood and doctors couldn't get the bleeding to stop. As my life slipped away, docs warned my partner, to expect the worst as he stood helpless with our baby in his arms. He was left praying for a miracle - and fortunately for us, those prayers were answered. "My instincts told me all was not well. There is Cancer in my Dad's side of the family and thats what kept nagging away in my mind" But what choices did I have? Ttreatment at that time would have damaged my baby. I didn't want to face that, so I just retreated into myself and kept my fears secret. After months of chemotherapy, radiotherapy and a last chance 24 hour bombardment of radiation directly onto the tumour, I was eventually in remission. I had sailed through a trouble free pregnany with my first daughter, Jordan whom was diagnosed with Asberger's Syndrome when she was 6. But I have to admit, the minute I fell pregnant with Aaron, I felt very ill. I was sick all the time, I was in pain, I couldn't eat, and nothing could convince me that this was a normal pregnancy. When I was expecting Jordan, my partner and I backpacked to India just in time before settling down with children. I felt so well throughout the pregnancy, mind you I was always relatively fit and healthy having just spent almost 7 years as a Military Policewoman in Her Majesty's Services. This time I thought, well no 2 pregnancies are the same. I remember my partner and I agreeing that there would be no more babies for us. I was dragging myself through the pregnancy. I couldn't wait for it to be over. Every now and then I'd start bleeding and end up in hospital. But I think because of the position of the tumour, it simply didn't show up. When I was 8 months pregnant, I was back at hospital for the umpteenth time after bleeding. I've got a rare blood group 'O' negative, so whenever I would take a bleed I'd have injections to stop the baby's blood being poisoned. This time the doctor said she was concerned because I'd been in so often, that she'd like to examine me further. Nothing was showing on scans so she examined internally. The pain was unbearable. Then she told me there was a growth the size of a mans fist in my cervix. I had a biopsy and had to stay in hospital for the results. That night was awful. I lay awake wondering what was going to happen to us. Next day they told me. I had Cancer, and because of the tumour, I wouldn't be able to deliver my baby normally, I was in shock. I was rushed into theatre for an emergency c-sect. The baby was perfect I was so relieved. But when I was in the recovery ward, my partner noticed that my bed was suddenly saturated in blood. The room was suddenly filled with nurses, but by then I was slipping in and out of consciousness. I vaguely remember nurses wrapping me up in silver foil. They were wrapping themselves around me too, trying to raise my body temp. I was rushed back into theatre, and, after about 2 - 3 hours, the doctor came out and told my partner he was sorry but he couldn't stop the bleeding. He asked my partner to sign a form permitting them to give me a hysterectomy. My partner said, "My partner is dying in there - just do what you have to do to save her" I spent a while in hospital while my partner looked after the girls. When I eventually did go home I was really worried about all the time I been apart from my girls, I hadn't had a proper chance to bond with my newborn. A bed was made up for me in the livingroom and I began my chemotherapy and radiation treatment the following week, just after New Year. Sadly despite an intensive course of 20 treatments the tumour was still there. I couldn't believe it, after all that the cancer was still there. During this time my partner was giving me intensive Healing through Crystals, (Kes is a fully qualified Holistic Crystal healer) and this helped immensly, his Sister Al would visit me (she is a qualified Reflexologist) and heal my body through healing to my feet and a friend from Cancer Care came along weekly and gave me some hands on healing, all in which played a big part in my recovery, that I am positive of. I was then offered a 24 hour intensive course where they would bombard me with radiation non stop using long metal rods directly onto the tumour. It was ghastly. I couldn't move for 24 hours but in the end, the tumour had shrunk. To be honest I think it was the nurses and doctors who kept me sane. When the tumour shrunk, I was still ill, but very very happy. But along with the tumour, other organs had also shrunk and I needed more surgeries to repair the damage. I had ignored the little voice in my head which told me I had Cancer. Like many people, I didn't want to hear that because I knew that any treatment would seriously damage or kill my unborn baby. Today though, I have 2 beautiful girls and a future. My daughter Aaron celebrated her 9th birthday at Christmas which is always a really special time for us all. I've since had to cope with more operations, skin grafts, scars, reconstructive surgery, however am now enjoying life hospital free, and with my family by my side............................well I made it and later married my partner Kester Fernando on the 10th anniversary of the day we met. In a romantic ceremony at the Blacksmiths cottage in Gretna Green, Scotland accompanied by our two girls and friends, we tied the knot - & were overcome with emotion. We were not the only ones. It was the happiest day of my life, after all we have been through. Everyone was crying at the ceremony, it was a very emotional service. It was a beautiful day and very romantic. We all went onto enjoy a wedding celebration in Annan in cottages overlooking the Solway Firth, with the memories of darker days well behind us. We have come through a lot since we met in Blairgowrie in jun 95, when I had just left the military police to start work as a private investigator and met my portugese beau Kes.We all enjoyed the day especially our girls Jordan and Aaron and will be a day we will never forget. I've since took part in the "race for life" Cancer Research Charity race every year and wow what a day, very emotional with a hint of excitement and nerves all rolled into one. I usually run on behalf of my late Grandad Scott (a tall and very proud man) and my dear friend "Tam the Gun" who sadly died of Cancer, (he fired the 1 o'clock gun at Edinburgh Castle for over 20 years, we became very good friends when I served up in the castle for many years as a Military Policewoman, we kept in touch frequently over the years). My daughters now join me in the race and neither of us would miss it for the world, we all have a fantastic day knowing how much we could be helping to save someone's life. I've since built my own business and am now working in the field of childcare, am currently writing my first book, continue to work alongside Cancer Research, Jo's Trust & the Scottish Government and am continually raising funds throughout the year for various cancer charities. I am now officially Scotland's first Cancer Research UK Ambassador, a fantastic post I recently accepted. I recently had the pleasure of being invited by my local MP Katy Clark to the 'International Women's Day' & meeting The Prime Minister at No.10 to discuss new policies on Cervical Screening and raising cervical awareness. I have managed to gain plenty of media attention through radio and newspapers for my local Cancer Care organisation too. My main aim now is to introduce a Cervical Cancer Awareness month here in Scotland! http://www.fightcervicalcancer.org.uk/more-information/personal-stories/talking-together.aspx

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